This document discusses oral candidiasis, caused by the yeast Candida albicans. It presents various classifications and investigations for candidiasis, including smears, swabs, and cultures. Management involves identifying predisposing factors and using topical or systemic antifungal drugs like amphotericin B, nystatin, clotrimazole, ketoconazole, fluconazole, itraconazole or miconazole. For HIV patients, highly active antiretroviral therapy (HAART) is recommended along with antifungal drugs to treat oral candidiasis.

1. Kingshuk Mazumder
Final year BDS

2. • Introduction
• Etiology
• Classification
• Investigations
• Management

3. • Oral candidiasis is the most prevalent
opportunistic infection affecting the
oral mucosa, caused by the yeast,
Candida albicans.

4. Local predisposing factors
for candidiasis
General predisposing
factors
• Denture wearing
• Smoking
• Atopic constitution
• Inhalation steroids
• Topical steroids
• Hyperkeratosis
• Imbalance of oral
microflora
• Quality and quantity of
saliva
• Immunosuppressive
diseases
• Immunosuppressive drugs
• Chemotherapy
• Endocrine disorders
• Hematinic deficiencies

5. Accordingly, candidiasis may be classified into:
1. Acute
2. Chronic
3. Pseudomembranous
4. Erythematous
5. Plaque like
6. Nodular
7. Candida associated lesion: Denture stomatitis,
angular chielitis

6. • Investigation of candidiasis, is by isolation of
Candida from oral samples, by-
1. Smear: Smear from the affected area, which
compromises of the epithelial cells, creates
opportunities for detection of yeasts. The
obtained material is fixed in isopropyl alcohol,
and air dried, and then stained with PAS. The
detection of yeast, indicates infection.
2. Swab: Taken by rubbing cotton tipped swabs,
over the lesional tissue.

7. 3. Imprint Culture: Sterile plastic foam pads
dipped into Sabouraud (Sab) broth, is placed over
a lesion for 60 seconds. Pad is pressed on Sab
agar plate, and incubated.
4. Impression culture: Maxillary and mandibular
alginate impressions; casting in agar; fortified with
Sab broth; incubation.

8. 5. Salivary culture: Patient expectorates 2ml
saliva into sterile container; vibration; followed by
culture on Sab agar by spiral plating; followed by
counting.
6. Oral Rinse: Subject rinses for 60 seconds with
Phosphate buffered saline (PBS), at 7.2 pH, 0.1 M,
and returns it to the original container. This is
concentrated by centrifugation, cultured, and
counted as in previous methods.

9. • Management of candidiasis is on the basis
of identifying the predisposing factor.
• Most common anti-fungal drugs are
polyenes or azoles.
• Polyenes are not absorbed from the
gastro-intestinal tract, and are not
associated with developing resistance.

10. • Management by topical agents:
DRUG FORM DOSAGE
Amphotericin
B
Lozenge,
10 mg
Slowly dissolved in the mouth,
3-4 times/day after meals, for
2 weeks
Nystatin Cream Apply to affected areas 3-4
times/day
Clotrimazole Cream Apply to the affected areas, 2-
3 times/day, for 3 days

11. DRUG FORM DOSAGE
Ketoconazole Tablets 200-400mg tablets, taken
once or twice daily with
food, for 2 weeks.
Fluconazole Capsules 50-100 mg capsules, once
daily, for 2-3 weeks.
Management by Systemic drugs:

12. • Type III denture stomatitis may be treated with
surgical excision, if necessary, to eradicate
micro-organisms seated in the deep fissures of
granulation tissue.
• Systemic azoles may be used for deeply seated
primary candidiasis, such as chronic hyperplastic
candidiasis, denture stomatitis, and median
rhomboid glossitis.
• Development of resistance is common for
Fluconazole, in HIV patients. Ketoconazole and
Itraconazole, are the suggested anti-biotics.

13. • In general, antiretroviral therapy is recommended for any
patient with a history of AIDS defining illness. Available
retroviral drugs are classified into:
1. Fusion Inhibitors
2. Nucleoside Reverse Transcriptase Inhibitors
(Eg: Abacavir, Didanosine)
3. Non-Nucleoside Reverse Transcriptase
Inhibitors (Eg: Delavirdine, Efavirenz,
Nevirapine)
4. Protease Inhibitors (Eg: Amprenavir, atazanavir)

14. The treatment of HIV requires HAART (Highly active anti-
retroviral therapy) combination therapy, like:
• 1 NNRTI + 2NRTIs
• 1 or 2 PIs + 2 NRTIs
• 3 NRTIs
In addition to the HAART therapy for HIV management, the
patient is prescribed systemic azoles for the treatment of
oral candidiasis, like Fluconazole tablets or Ketoconazole
capsules.
In case of resistance to the above, itraconazole and
miconazole are the suggested alternatives.
The azoles are also used in the treatment of secondary oral
candidiasis, associated with the systemic predisposing
factors, in systemic candidiasis.

15. Thank You